Original Article

A holistic care approach to combat the COVID‑19

disease
Priya Kotwani1, Vaibhav Patwardhan1, Geetika Madan Patel2,
China‑Lee Williams1, Ekta Modi3
1
Parul Institute of Public Health, Parul University, P.O. Limda, Ta. Waghodia Vadodara, 2Parul Institute of Medical Sciences and
Research, Parul University, P.O. Limda, Ta. Waghodia Vadodara, 3Parul Sevashram Hospital, Parul University, P.O. Limda,
Ta. Waghodia Vadodara, Gujarat, India

A bstract
Background: Coronavirus disease‑2019 (COVID‑1) 9 pandemic is spreading like a wildfire across the globe. For its containment,
measures such as isolation and quarantine are followed. The patients tested positive for COVID‑19 disease are kept in isolation with
no interaction with the family members leading to negative mental health consequences. To address this, Parul Sevashram Hospital
adapted to a more holistic approach to treatment. Methodology: A process documentation of the best practices was undertaken.
Key Informant Interviews (KIIs) were used to gather responses of the project implementers (n = 2), physiotherapists (n = 2),
dietician (n = 1), Ayurveda practitioners (n = 2), and staff nurses (n = 2) who were mainly involved in tailoring the package of
services to be offered as well as their implementation. In addition, KIIs were also conducted with the patients (n = 10) their views
on the additional package of services offered to them and the overall level of satisfaction with the care. Findings: The holistic care
services involved diet therapy, physiotherapy and yoga, AYUSH medicines for boosting immunity, music therapy and books and
indoor games. Few implementation challenges include convincing healthcare workers for providing care to COVID patients, availing
raw materials for preparing AYUSH medicines during lockdown. Trainings were also provided to HCW on infection control practices,
provided monetary incentive and mobilised the existing resources for addressing the challenges. Conclusion: The holistic care
has potential influence on patient’s mental health, recovery rate, and satisfaction of COVID‑19 patients. These approaches can be
up‑scaled with a minimum investment and has a potential to benefit patients both in public and private hospitals.

Keywords: COVID‑19, holistic care, mental health, patient satisfaction

Introduction infected individuals were unaware that they were infected.[1]

The world is combating the ongoing COVID‑19 pandemic. The
widespread impact of COVID‑19 resulted in the implementation
of stringent public health measures to lessen the incident rates of
the virus.[1] COVID‑19 presented itself with flu‑like symptoms
in majority of the cases, which meant a large percentage of
Address for correspondence: Dr. Geetika Madan Patel,
Parul Institute of Medical Sciences and Research, Parul University,
P.O. Limda, Ta. Waghodia Vadodara, Gujarat ‑ 391760, India.
E‑mail: medicaldirector@paruluniversity.ac.in
Received: 28-07-2020 Revised: 29-09-2020
Accepted: 28-10-2020 Published: 27-02-2021
Access this article online
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Website:
www.jfmpc.com
These symptoms consisted of a mild fever, sore throat, cough,
fatigue and shortness of breath. A staggering amount of
cases were asymptomatic, where infected individuals showed
no clear symptoms related to COVID‑19. As the number of
cases increased, the death toll followed, and considering no
cure existed, prevention strategies to disrupt transmission were
implemented globally.
Mass testing was encouraged and once tested positive the
individuals were kept in isolation centres for a period of 14 days,
the indicated incubation period.[2] During this period the patient is
shut out from the world, contact is restricted to only the medical
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DOI: How to cite this article: Kotwani P, Patwardhan V, Patel GM, Williams CL,
10.4103/jfmpc.jfmpc_1549_20 Modi E. A holistic care approach to combat the COVID-19 disease. J
Family Med Prim Care 2021;10:844-9.

© 2021 Journal of Family Medicine and Primary Care | Published by Wolters Kluwer ‑ Medknow 844
 Kotwani, et al.: Comprehensive Care Delivery for COVID-19 Disease
staff who monitors the patient on a regular basis.[3] Suspected
cases are confined to quarantine facilities for the same amount
of time, and tested before they are allowed to leave again.[3]
Presently, India has the third‑highest recorded cases
(1.04 million cases) with 654 recovered, and 26,273 recorded
deaths.[2] An upsurge in cases consequently also resulted in
a larger percentage of the population being kept in isolation
for the specified recovery duration. Although these measures
were necessary, the negative underlying effects of prolonged
isolation on mental health outcomes, especially among
COVID‑19 patients became more evident.[4] Limited interaction
with family members, or loved ones, and being confined to
just one space or building, reasonably so, affected the mental
wellness of the COVID‑19 patients. Besides, many researchers
linked depression, feeling of helplessness and suicidal thoughts
with prolonged isolation and fear of the unknown.[4,5] The panic
caused by the media, and the negative narrative portrayed painted
COVID‑19 as a death sentence, resulting in stigmatization of
positive patients and feelings of self‑pity.[4] This required the
broadening of COVID‑19 treatment efforts, to not only address
the effects of the virus on the body, but also possible effects
on the patients’ mental health calling for a more comprehensive
approach to dealing with COVID‑19. As per WHO, primary
healthcare encompasses broader determinants of health that
largely covers all the aspects of health and wellbeing holistically.[6]
This holistic approach by the primary care physicians towards
the current outbreak—as well as the measures taken to control it
will have a profound impact on psychological and socioeconomic
well‑being.[7] The Parul Sevashram Hospital located in Vadodara,
is one of the healthcare facilities in India that implemented
this strategy of focusing not only on improving mental health
outcomes of COVID‑19 patients, but also incorporating AYUSH
Medicines (traditional herbs and medicines) designed to boost
immunity into the patient’s treatment regimes.
Although the allopathic medicine is at the forefront for dealing
with the menace of ongoing pandemic, the potential of
complementary and alternative medicines (CAM) should be
considered as an adjuvant therapy.[8] The CAM provide a holistic
approach to therapy as they help strengthen the immunity of
the patient to battle the disease.[9] In addition, practices such as
yoga (postures), seated meditation and pranayama (breathing)
are known to have anti‑stress and anti‑inflammatory effects and
thereby can help reducing the severity of COVID‑19 disease.[10]
During this pandemic although priority is given to the successful
recovery of the infected patients, the medical board of the Parul
Sevashram Hospital went one step further. The holistic COVID
care and management package offered to positively diagnosed
cases encompassed not only treatment towards recovery, but also
accounted for adverse psychological effects caused by being in
isolation, working towards healing the body, mind and soul of the
patient. The package focuses on five elements to full recovery, viz.
(i) Diet Therapy, which ensures a healthy and nutritious diet
plan to all patients,
Journal of Family Medicine and Primary Care
(ii) Music Therapy which evokes relaxation,
(iii) Yoga and Exercise Therapy,
(iv) Productive Engagements, which includes reading books or
playing games with the patients, and
(v) AYUSH medicines, which as mentioned before acts as
immune boosters and consist of traditional Indian medicines
and herbs.
With this approach, the Sevashram Hospital not only ensures the
absence of physical ailments after the treatment process, but also
addresses the possibility of mental and social infirmities, which
in essence is the WHO regulated definition of health.
Methodology
To document the process of delivering the holistic care services
to COVID‑19 patients admitted to COVID Care Centre (CCC) at
Parul Sevashram Hospital, Key Informant Interviews (KIIs) were
used to gather responses of the project implementers (n = 2)
on the rationale for conceptualising the holistic care package
of services for COVID‑19 patients. In addition, KIIs were
also conducted with physiotherapists (n = 2), dietician (n = 1),
Ayurveda doctors (n = 2), and staff nurses (n = 2) who were
mainly involved in tailoring the package of services to be offered
as well as their implementation.
The KIIs were conducted with the help of interview guide which
had questions regarding rationale behind the conceptualisation of
the holistic care package, services included in the basket of holistic
care and the implementation strategy, early implementation
challenges and addressal mechanism adopted to manage those
challenges.
Moreover, inter views were also conducted with the
patients (n = 10) to know whether they were aware of the holistic
care of services that was offered to them, how did they utilise
those services, their views on the additional package of services
offered to them and the overall level of satisfaction with the care
received at Parul Sevashram Hospital.
Institutional Permission to carry out the process documentation
of holistic care services was sought. Enrolment of the study
participants was voluntary and they withdraw at any time. Written
informed consent was obtained from the all the participants after
explaining to them the study objectives, research methods and
data collection techniques were explained to and understood
by them.
Findings
The nature of the ongoing pandemic of COVID‑19 is such
that the individuals tested or suspected to be positive for the
disease require to stay under isolation for containing the disease.
Thus, during the initial days of establishment of CCC at Parul
Sevashram Hospital, it was noticed by the healthcare workers that
the patients often get irritated or frustrated during their long‑stay
845 Volume 10 : Issue 2 : February 2021
 Kotwani, et al.: Comprehensive Care Delivery for COVID-19 Disease

in the hospital and due to restrictions on social interaction
imposed by the disease itself. Keeping in mind the behaviour
of the patients as well as the tendency to have a personalised
approach to the patient issues, the hospital management identified
the need to engage the patients into various health‑promoting
activities. Therefore, the team of project implementers designed a
package of holistic care services wherein the patients can engage
in activities to cheer them up as well as services that would boost
their immunity and improve their recovery.
Features of the holistic care services
Figure 1 highlights the composition of the five services offered
to COVID‑19 patients admitted to CCC at Parul Sevashram
Hospital [Figure 1]
a. Diet Therapy‑ The COVID‑19 patients were provided with
tailored diet. The diet provided was rich in protein, low on
carbohydrates and fats. The diet was also enriched with a lot of
antioxidants by including garlic, spices such as turmeric, clove,
cinnamon, cardamom and medicinal herbs like Tulsi which
are known to reduce chest congestion.[11] Patient were given
homely care and were provided with five meals a day. In addition,
patients were provided with decoction (kadha) in the morning
and Turmeric milk at the night. Also, provision for 24 × 7
availability of lukewarm water was made. Besides, dietary need
of the patients with co‑morbidities was also taken care of. Daily
feedback from the patients were collected on the meals provided
to them and variety in the daily meals was assured by the dietician.
b. Yoga & Exercise Therapy‑ The CCC was equipped with
television where Upayoga (simple Yogasanas for beginners
which focus on exercising joints and muscles) were taught
once from seven to eight in the morning. In addition, a
team of physiotherapists trained the patients for performing
breathing exercises and deep breathing with the intention
of strengthening their respiratory muscles. Physiotherapists
delivered these sessions in group for the mildly symptomatic
patients admitted in CCC. However, for the patients admitted
to the Intensive Care Unit with an ability to perform mild
breathing exercises were trained to perform specific set
of chest exercise (viz. Thoracic mobility exercise, Chest
Expansion exercise, Diaphragmatic breathing, etc., on
one‑to‑one basis for 15 minutes. The participation of the
patient was purely voluntary even then most of the patients
preferred being a part of the session.
c. AYUSH KIT‑ At the time of admission, the patient is provided
with a kit which mainly comprises of Ayurveda medicines
having a targeted effect on the body system (Medicine & its
Uses in Table 1).
The kit was designed after consulting a group of expert Ayurveda
practitioners. Knowledge regarding the benefits of AYUSH
medicine was provided, however, the consumption of
medicines was left to patient’s will.
d. Music Therapy‑ The provision was made for offering soothing
music along with ‘AUM’ chanting through the mode of
television as a relaxation therapy. The patients were made
aware of this provision and could listen to it at one’s own will.
e. Books and Indoor Games‑ to keep the patients engaged a
large variety of books for all age‑groups were provided in
CCC. Apart from this, provision was made for the indoor
games such as Chess and Carom.
Human resource involved in delivering holistic care
The figure below highlights the various specialities of health
workforce that was involved in delivering the package of services
as well as their key responsibilities [Figure 2].
Early implementation issues & challenges and
mechanism for their addressal
The first and the foremost challenge that the Project Implementers
faced was to convince the healthcare staff to deliver the care to

Figure 1: Package of Holistic Care

Table 1: Composition of AYUSH Kit

Medicine Uses Dosage
Samashamani Vati Indicated for febrile illness, and boosting immunity 500 mg tablet to be taken thrice a day
Khadiradi Vati sore throat and indicated for upper respiratory tract infections 250 mg tablet to be taken twice a day
Dashamula Katutraya Dhanavati upper as well as lower respiratory tract infections 250 mg tablet to be taken thrice a day
Sudarshana Dhanvati Indicated for febrile illness 250 mg tablet to be taken thrice a day
Nasya Shadbindu Taila (nasal drops) Indicated for rhinitis 2 drops in each nostril twice a day

Journal of Family Medicine and Primary Care 846 Volume 10 : Issue 2 : February 2021
 Kotwani, et al.: Comprehensive Care Delivery for COVID-19 Disease
Figure 2: Roles and responsibilities of human resource involved in delivering Holistic Care services
COVID‑19 patients. Considering the hesitation of staff, series
of online trainings from experts were arranged regarding the
strict infection control practices that should be followed, and
donning and doffing od personal protective equipment (PPE) kit.
In addition, both the medical as well as paramedical staff were
asked to offer their services on rotation basis. They performed
their duties in the CCC and COVID‑19 ICU for seven days
following which they were kept in home quarantine for the
next seven days. On resuming the duties, they were posted to
non‑COVID wards. This helped in limiting the exposure of
healthcare workers to SARS‑COV‑2 virus. Moreover, monetary
incentives were also provided to the healthcare workers rendering
services to COVID‑19 patients.
The other major challenge that came up was to procure essential
item for delivering care during the COVID‑19 induced lockdown.
The institution was short of ingredients required to produce
AYUSH kit in large quantities. After repeatedly persuading the
manufacturers, raw materials were made available. The internal
human resource was mobilised to then prepare indigenous
AYUSH drug kit. It was also difficult to procure variety of
vegetable to make sure that the diet provided to the patients does
not become monotonous. It was also a challenge to procure new
TV sets and Books, hence the already existing resources were
mobilised and provided to the COVID‑19 patients.
After initiating the delivery of holistic care, it was necessary
to assure its proper utilisation. To address this, social worker
approached the patients individually and made them aware of
various services arranged for them. Few of the patients initially
were reluctant to adopt the AYUSH kit. For this, Ayurveda
practitioners counselled those patients telephonically and made
them aware of its various benefits.
Patients’ response to holistic care
A very warm response was received from the patients when
they were approached to give their feedback on the Holistic
Care that they received. This mix of services helped patients
Journal of Family Medicine and Primary Care
keep themselves engaged the entire day and did not feel lonely
in absence of their family members around. One patient said
I am getting discharged today. It is my fifteenth day here in
Parul Sevashram Hospital and I felt very homely during my stay.
I made new friends and also enjoyed playing games with them
in the evening.
The other patient who was a teacher by profession said
I made use very productive use of my time at isolation ward. They
provided with variety of books which I read during afternoon.
This also motivated me to write my own poems. This time helped
me relive my hobby.
The patients were very satisfied by the personalised care they
received during their isolation period. They liked the food that
was offered, immediate redressal of the issues they had by the
staff nurses. All the possible measures were taken by the hospital
management that patients do not return home with any bad
memories.
Discussion
Researchers globally have been consumed in prioritizing
the discovery of a cure or possible vaccine for COVID‑19,
however, the psychological effects this pandemic has had on
the public seem to fall short in importance. The fear of the
unknown, combined with the negative narrative portrayed
by the media and being kept away from your loved ones for
extended periods decrease the person’s will to overcome the
virus and be actively involved and abide to the treatment
regime specified by the doctors. An evident increase in suicidal
behaviours or thoughts have also been linked to prolonged
self‑isolation and among patients confined to isolation centres
after positive diagnosis.[12]
To positively respond to the COVID‑19 treatment provided in
isolation centres, the importance of a health mind and psych is a
847 Volume 10 : Issue 2 : February 2021
 Kotwani, et al.: Comprehensive Care Delivery for COVID-19 Disease
fundamental factor to healing the body.[13] A healthy functioning
mind positively impacts the overall healing capability of the body.
Selective health professionals, across the globe, have considered
alternative & complimentary medicines to combat COVID‑19
infection, in addition to the conventional treatment.[14] As
mentioned earlier, COVID‑19 more severely effects individuals
with an impaired immune response, hence boosting the immune
system has been identified as an effective response to the virus.[14]
The public is advised to consume a healthy diet and to also invest
in immune‑boosting options like citrus fruits. Additional activities
like regular exercise, limiting alcohol and tobacco intake and
regular sleeping patterns are also beneficial &contribute towards
a better immune response.[14]
A Holistic medicinal approach embraces both modern and
complimentary treatment methods.[15] The Holistic care possesses
the potential to content the health providers and researchers
by showing them the resourcefulness and paybacks of the use
of complimentary or alternative medicine in sync with the
modern medicine including both medicinal and surgical. The
Holistic Care is reported to be advantageous for both service
provider and receiver.[16,17] The Comprehensiveness of holistic
care package offered at CCC of Parul Sevashram Hospital that
included nutritious diet and other immunity‑boosting therapies
significantly helped in patients’ recovery. Moreover, the yoga,
meditation, and breathing sessions in addition to amusing indoor
games and books further relaxed the psychological distress due
to the isolation and the disease.
Considering the above‑mentioned studies and their reported
positive outcomes and through the patient feedback received during
the process documentation of Holistic Care, we can recommend
that such comprehensive care approaches should be encouraged
at a greater scale. The incorporation of such novel practices in
treatment of COVID‑19 pandemic will significantly augment the
quality of care and condense the negative psychological aspect
of isolation and hospitalization. Further, such patient‑centric
approaches must be encouraged to enhance the quality of life of
COVID‑19 positive patients kept in isolation. These services can
be incorporated with a minimum investment and a possibility to
gain greater returns in public and private hospitals.
The aforementioned services can have potential influence on
patient’s mental health, recovery rate, and patient satisfaction
of COVID‑19 patients. However, future research is required to
evaluate and quantify the impact of the ‘Holistic Care Approach’.
Acknowledgement
We would like to acknowledge the study team members viz.
Dr. Shailesh Deshpande, Ms. Charmi Shah and Dr. Noopur Bhatt
Financial support and sponsorship
Nil.
Journal of Family Medicine and Primary Care
Conflicts of interest
There are no conflicts of interest.
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